Peabody-award winning journalist Doug Levy covered medicine for USA TODAY and other major media for more than 10 years. On this blog, he posts observations, commentary and quirks on the road or from his home base in San Francisco. For more about Doug, visit douglevy.com. For Doug's commentary about food and wine, visit wineandfoodworld.com.

Tuesday, March 15, 2011

Dr. Irwin Redlener on ABC's News 20/20 discussing disaster preparedness in the United States

Japan has long been a leader among nations in disaster planning and preparedness. But the devastating earthquake and tsunami that struck on March 11, 2011, demonstrated how a complex disaster can overwhelm even the best of planning.

Dr. Redlener, a faculty member at the Mailman Schoo of Public Health at Columbia University Medical Center, shared his thoughts on the unfolding catastrophe in Japan and the state of U.S. disaster preparedness.

What can we learn from the devastation in Japan?This catastrophe is a very complex disaster – there was an earthquake, followed by a tsunami followed by hundreds of aftershocks followed by significant threats to the country’s nuclear power plants. The management of this situation is extremely challenging. It’s extraordinarily difficult to get everything right when a disaster is unfolding – but with a complex disaster, the challenges can be literally overwhelming.

Japan has been recognized as having the most robust disaster planning of any nation on earth, particularly when it comes to earthquakes and tsunamis. But what we’ve seen is a good system that is far from perfect. There will be extraordinarily high fatalities. Part of it due to failure to get search and rescue equipment in as early as possible to the places most severely affected and partly due to the fact that a disaster of this magnitude and nature is impossible to manage. There simply isn’t enough warning time for people in some areas to escape an oncoming tsunami.

We’re beginning to see lots issues like children separated from their families and we’re already seeing problems with food and water getting to affected areas and so forth. There are many lessons for us observing here in the U.S., but the fact remains that the U.S. is far less prepared than Japan is for this kind of disaster.

Five years after Katrina, why isn’t the United States better prepared for a disaster of this magnitude?

There are many issues that have undermined our ability to get as prepared as we want to or need to be. Even after the 9/11 attacks and Hurricane Katrina we have not been able to muster sufficient resources and coordination to develop a cohesive and effective plan to respond to future disasters. Part of it has to do with the multiplicity of agencies that have responsibility for different aspects of disaster planning, part of it is too few resources and unfortunately, there are some major systemic barriers in government itself. For instance, while the federal government can issue guidelines and guidance for specific grants, it’s really up to states and local governments to do what they think is best in terms of disaster preparedness policies. This has resulted in a patchwork of random preparedness activities that, together, do not amount to a significantly robust national state of readiness.

What should be the government’s priorities? Is it first dealing with these systemic issues?

If I were designing a better system to oversee nationally significant megadisaster planning, I would empower a single individual or agency to develop a national plan that has explicit authority and sufficient resources. Money that goes to states or local governments for public health preparedness should come with very explicit strings attached specifying what states and localities would be required to do towards the goal of getting the whole country prepared.

This would take into account that certain regions have different priorities (earthquakes versus floods), so state plans would have to be customized to some extent to meet local and regional needs. But at the end of the day we’re going to need much greater attention to ensuring that the basics are covered, for instance, that, as a nation we have sufficient training of public health officials in how to respond to disasters, and make sure that we have adequate surge capacity in hospitals to respond to pandemics and other large scale emergencies.

I also want to add that if you don’t plan thoroughly in advance for how to handle vulnerable populations – children, elderly – these individuals will suffer disproportionately - and will also consume significant resources to protect them during a major crisis.

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About Doug Levy

Longtime health reporter Doug Levy is now chief communications officer at Columbia University Medical Center in New York, NY. Levy is a Peabody-award winning investigative reporter, formerly with USA Today, United Press International and National Public Radio, among other media.